Treating male infertility - Daily Nation

Jared and Sarah wanted a baby. Before they got married, Sarah had wanted four children while Jared wanted two. Finally they settled on three. They did not mind the sexes of the children. Like any modern couple, their aim was to provide the best for their children so that they realise their full potential.

“So nature seems to be working against our aspirations,” Jared said when he came to the sexology clinic, “seven years down the line in this marriage and no baby to show for it.” Jared was a 42-year-old architect running his own company. He was married to Sarah, a 36-year-old teacher. They had hoped to have a baby in their first year of marriage but alas, it slipped through and the trend continued for seven years.

“I have tried everything including herbs,” he said “I sincerely cannot tell where my wife is suffering from, making it hard for her to conceive.”

Sarah had undergone gynaecological examination and tests, which showed that her fallopian tubes and uterus were normal. She had also done hormone tests and the results were also normal. No tests had, however, been done on Jared since he believed that he was not the cause of the infertility.

“I had a girlfriend before I got married, and she got pregnant and gave birth to a bouncing baby girl,” he said, “how on earth can you now say that I could be having a problem?”

And then he changed the topic. “So fertility aside, I am here due to this emerging problem that is stressing me,” he said, “my erections seem to be failing and I have this nagging pain in the testis.” He had visited a number of clinics where they did urinalysis and repeatedly gave antibiotics with no improvement. He had also been put on viagra on and off. The weakening of erections worsened with testicular pain. The pain was dull in nature and worsened by physical activity.

I examined Jared and all his body systems were normal. His genitals also appeared grossly normal. There was only mild pain on the left testis but no obvious swelling. It was impossible to decipher Jared’s problem at that point so I ordered for tests.

Jared’s urine test showed no abnormality. I also did hormone tests — his testosterone and other hormones were all normal.

Because of problems of fertility, I ordered for semen analysis even though Jared was convinced that it was unnecessary. But as fate would have it, it showed subnormal sperm counts with poor formed sperms, which could not move. Sperms need to be able to move to meet with the woman’s egg for conception to happen.

To uncover the mystery of testicular pain combined with abnormal sperm production, I ordered for an ultrasound of the testis. It showed severe varicoceles on both testes.

A varicocele is a swollen vein in the testis. It is basically a varicose vein. A varicose vein pools blood and limits its flow away from the testis. This makes the testes too warm, disrupting its normal function. It is estimated that 10 — 25 per cent of men have varicoceles and that in most cases, they are mild, causing no interference with testicular function. In some cases, however, the accumulated blood not only alters the temperature around the testis but also accumulates toxins that diffuse into the testicular cells causing damage, including interference with sperm and testosterone production. It can even cause the death of testicular cells. Varicoceles can therefore lead to softening and shrinking of the testis. Most men with varicoceles have no symptoms. In a few cases they may cause obvious swellings in the testis but this is the exception rather than the norm. Other men experience dull pain.

“Yes, mine seems to be just painful,” Jared interjected, “I am surprised how much damage it has done to my manhood!”

Interference with sperm production leads to infertility. Persistent pain may affect sexual function and present as erectile dysfunction. Whenever there is pain around the genitals, the tendency is to have dwindling erections.

“If you have medicine for this problem I will appreciate doctor,” Jared said anxiously, “I hope it is treatable, this is a disaster and my marriage is hanging in the balance.”

Well, varicocele that causes pain interferes with sexual function or causes infertility calls for surgical treatment. Surgery is done to correct the swollen vein and hopefully the function of the testis reverts to normal.

Jared underwent surgery. He recovered with no complications. I reviewed him a month later and the testicular pain was markedly improved. It has been six months down the line and he called me last Friday really excited because his wife had just had a positive pregnancy test. “I have concluded that you were right, a woman can fail to conceive because the man has a problem,” he said, “now my next task is to prove that the child I got with my first girlfriend is actually mine!” I, however, informed him that varicocele-related infertility can occur later in life in a man who was originally fertile. I saw no need in opening a Pandora’s box in the name of proving paternity.